=====================================================
General NPI Number Information
=====================================================
NPI Number | 1174783419
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MICHAEL JOSEPH GEREMINO D.D.S.
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/10/2008
-----------------------------------------------------
Last Update Date | 01/30/2015
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 47 BROOKFIELD PL
-----------------------------------------------------
City | PLEASANTVILLE
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 10570-2107
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 914-769-0065
-----------------------------------------------------
Fax | 914-769-3214
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 47 BROOKFIELD PL
-----------------------------------------------------
City | PLEASANTVILLE
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 10570-2107
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 914-769-0065
-----------------------------------------------------
Fax | 914-769-3214
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1223G0001X
-----------------------------------------------------
Taxonomy Name | General Practice Dentistry
-----------------------------------------------------
License Number | 043421
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------